Retrospective analysis of surgical treatment of closed-angle glaucoma with persistent high intraocular pressure

Abstract:

AIM:To observe the safety and clinical curative effect of trabeculectomy on continuous high intraocular pressure(IOP)in primary angle-closure glaucoma.

METHODS:From January 2013 to January 2015, 45 patients(46 eyes)with high IOP in primary angle-closure glaucoma were treated in the department of ophthalmology in our hospital. The age of patients was(56.9±9.4)years old, ranged from 43～81 years. All the patients underwent the examinations of visual acuity, best corrected visual acuity(BCVA), slit lamp, fundus IOP, perimetry and ultrasound B scan. Under local anesthesia, the patients underwent anterior chamber paracentesis, postoperative they received topical acetate prednisolone eye drops and tobramycin and dexamethasone eye ointment, combining with IOP lowering eye drops and glycerol fructose injection intravenous to further control IOP. Two days after surgery, the patients received trabeculectomy with amniotic membrane implantation and intracameral gas injection(some cases underwent pars plana puncture). Visual acuity, BCVA, IOP, slit lamp, fundus were observed postoperative and complications occurred during the operation were recorded.

RESULTS:The average IOP at 1 and 2d after anterior chamber puncture were 21.4±5.2, 20.3±4.8mmHg(1kPa=7.5mmHg), which was significantly lower than that before surgery(F=492.601, P<0.01); the average IOP after glaucoma filtration surgery was(20.1±4.8mmHg at 1d, 14.9±2.7mmHg at 3d, 13.6±2.7mmHg at 7d and 14.5±2.2mmHg at 1mo, which was significantly lower than those before surgery(F=857.508, P<0.01). After glaucoma filtration surgery, comparison between IOP at 1, 3, 7d and 1mo was performed, there was statistically significant differences were found(t=10.191, 10.950, 9.523, P<0.01). At the last visit, the functional filtering bleb formed in all cases. The fully success rate was 94%, the partially success rate was 7%. BCVA was significantly improved(P<0.05), and most of cases regain useful visual acuity. There were shallow anterior chamber in 3 eyes and chorildal detachment in 2 eyes, which were treated medically. Malignant glaucoma, retinal hemorrhage, suprachoriodal hemorrhage, eyeball atrophy and other severe complications did not occur.

CONCLUSION:For acute primary angle closure glaucoma with persistent high IOP, anterior chamber puncture and intracameral gas injection combined with trabeculectomy is a safe and effective method, which can reduce intraoperative and postoperative complications and improve the visual acuity of most patients.

Key words:persistent high intraocular pressure; anterior chamber paracentesis; intracameral air injection